Besides the lung focused symptoms which Long Hauler COVID patients experience, COVID patients fear the less common danger of blood clotting given its potential for devastating effects. While the rate of diagnosed blood clots up to 1 month after the acute infection lingers below 5% in most studies, the real chances are low. But, those patients who have a post COVID clot in the heart, lung, or brain can face a pulmonary embolus, a heart attack, or a stroke, all of which can be deadly. Besides the danger, the fact that these clots can occur up to 1 month after the infection ends means many will live in fear for weeks after the acute symptoms fade.
In many other similar diseases, acutely ill patients are more likely to suffer from excessive bleeding than blood clotting. This means COVID clots are more consistent with a hyperinflammatory and hypercoaguable state of the blood. In acute COVID, 20-30% of patients may have a clot (1). The clot inducing inflammation appears to works through endothelial damage, activation of the complement system, platelet activation and pro-inflammatory cytokines. The disruption of normal coagulation and the low oxygen states also contribute to the likelihood of unwanted, inappropriate clotting.
While the inflammation of acute COVID is much more severe, the likely ongoing low-grade inflammation of post-COVID likely contributes the increased risk weeks later.
Currently, conventional medicine is researching whether anti-coagulant medications or aspirin could lower the clotting risk. They are also considering whether a blood test called a d-dimer might help predict who is at greater risk of a clot. The d-dimer is a side-product of clotting that indicates a clot is present somewhere in the body if it is high. If the level is normal, the possibility of a clot is much lower. We could possibly differentiate which patients need a blood thinner and which do not.
In functional medicine, we do not have studies on the efficacy of natural blood thinners like omega 3’s, curcumin, vitamin E, or different enzymes on the risk of Long Hauler blood clots. While we suspect that each of these could lower the risk, we can not tell you yes or no or whether you should take an aspirin. We can say that we agree with the likely root cause being centered in hyperinflammation. From there we can focus on lowering that inflammation and hoping to lower the risk of complications like blood clots.
Restoring healthier lives means that we apply what we do know to the developing situation as far as we can to remove the obstacles preventing our patients from enjoying family time, work productivity, exercise and life in general. Restoring life is possible in Long Hauler Covid.
Ani Nalbandian, Kartik Sehgal, Aakriti Gupta, Mahesh V. Madhavan, Claire McGroder, Jacob S. Stevens, Joshua R. Cook, Anna S. Nordvig, Daniel Shalev, Tejasav S. Sehrawat, Neha Ahluwalia, Behnood Bikdeli, Donald Dietz, Caroline Der-Nigoghossian, Nadia Liyanage-Don, Gregg F. Rosner, Elana J. Bernstein, Sumit Mohan, Akinpelumi A. Beckley, David S. Seres, Toni K. Choueiri, Nir Uriel, John C. Ausiello, Domenico Accili, Daniel E. Freedberg, Matthew Baldwin, Allan Schwartz, Daniel Brodie, Christine Kim Garcia, Mitchell S. V. Elkind, Jean M. Connors, John P. Bilezikian, Donald W. Landry, Elaine Y. Wan. Post-acute COVID-19 syndrome. Nature Medicine, 2021; DOI: 10.1038/s41591-021-01283-z
Thanks to Science Daily:
Columbia University Irving Medical Center. “Long-haul COVID: Physicians review what’s known.” ScienceDaily. ScienceDaily, 22 March 2021. <www.sciencedaily.com/releases/2021/03/210322175018.htm>.
- Connors, J. M. & Levy, J. H. COVID-19 and its implications for thrombosis and anticoagulation. Blood 135, 2033–2040 (2020).
Sanctuary Functional Medicine, under the direction of Dr Eric Potter, IFMCP MD, provides functional medicine services to Nashville, Middle Tennessee and beyond. We frequently treat patients from Kentucky, Alabama, Mississippi, Georgia, Ohio, Indiana, and more... offering the hope of healthier more abundant lives to those with chronic illness.